BALTIMORE — Professional continuous glucose monitoring technology can give the diabetes educator an opportunity to go “beyond the finger stick” and capture key, masked patient data to better fine-tune therapy and lifestyle recommendations, but it is important to keep several key tips in mind when educating patients about how the system works, according to a speaker at the American Association of Diabetes Educators annual meeting.
Professional CGM, which is owned by either the health care professionals or the practice and requires a prescription, offers several advantages for diabetes educators and nurses working with adults with diabetes, Lucille Hughes, DNP, MSN/Ed, CDE, BC-ADM, FAADE, director of diabetes education and treasurer for AADE, said during a presentation.
With professional CGM, Hughes said, the devices are worn by the patient for up to 14 days, depending on the system, before being returned to the office for a data download. The patient, who is masked to any glucose alerts while wearing the device and receives no real-time data, can only see the information after it has been downloaded and analyzed by the health care professional.
“It’s going to uncover the things that we miss with regular finger sticks,” she said. “I started as a diabetes educator trying 31 years ago, trying to help patients that came to see me. You think back to that time — how many patients were really monitoring in a way that was going to help us help them? We spent a lot of time guessing, didn’t we? Just trying to get the root cause of the variations in glucose, and that was if we could even identify any variations. That is why I get so excited about this topic, because now I have the ability to see everything a patient is going through. To me, it is a gift, and I hope my patients see it as such.”
The professional CGMs, Hughes said, which are intended as adjunctive devices to complement standard glucose monitoring therapies, can uncover glucose characteristics that are missed by blood glucose meters, such as nocturnal lows, postprandial highs and total glucose excursion. Current professional CGM choices include:
Libre Pro CGM system
(Abbott) — Health care professional applies a sensor onto a patient’s arm in the clinic, which is worn for up to 14 days and records glucose readings continuously. The patient then returns to the clinic, where the provider scans the sensor to download glucose data. Reports generated from the data are interpreted by the provider and used in a patient consultation. “A little helpful hint,” Hughes said. “This system can work for 14 days. For my patients that may have an urgent need for a change, and where we may want to address things earlier, I can bring this patient back at day 5 or day 7, tweak things, and then evaluate the patient’s response to those changes at 14 days. So, keep that in mind if you haven’t been doing that.”
Medtronic iPro CGM system — The iPro 2 system includes three steps for setup, Hughes said, including inserting the Enlite sensor on the abdomen, connecting the iPro 2 recorder and dock and then training the patient. The sensor can be worn for up to 6 days and must be calibrated once every 12 hours, according to Hughes. “Remember that, with the iPro, you will need some finger sticks to calibrate,” she said. “You need to tell the patient it is four finger sticks a day, and you really want that to be in real time. I tell them to try to be a type A personality when you’re using this because it’s going to make the download information very accurate for me. It’s going to help get the most out of that download, when you’re doing that work.”
Dexcom G4 Platinum Professional — Like the iPro system, the Dexcom G4 system requires sensor calibration once every 12 hours, with the initial calibration following a 2-hour warm-up period. The sensor used in the G4 system is the same sensor used in Dexcom’s G5 and the G6 systems, Hughes said, which are approved to anyone with diabetes aged 2 years and older. “One thing about the Dexcom is they also have a feature that you allow you to use this blinded or un-blinded,” she said. “If you want the application to be more reactive and in real time, you can set it up to do it that way as well.”
“All systems have their own software, and my take is, whatever you’re using you will get used to,” Hughes said. “All of them are simple to use.”
When a patient is prescribed professional CGM, it is key to stress the importance of accurate blood glucose readings while wearing the system, according to Hughes. Inaccurate blood glucose data can lead to data gaps, whereas accurate meter setup with the correct date and time is “essential,” Hughes said.
“How many people here have come across patients with meters where the date on them is set to 5 hours ago, or 2 months ago?” she said. “That’s going to affect information you put into that download. You want this to be as accurate as possible.”
Patients should also be encouraged to keep an accurate logbook, recording all foods, medication, activity and anything that may affect blood glucose, Hughes said.
“I say, anything that crosses your lips, write it down,” she said.
The providers and the patient should also discuss the best way to return the system and download data — either come to the office, have staff remove the device, download data and review same day or have the patient remove the device at home, drop it off at the office, and then download and review data another day. – by Regina Schaffer
Hughes L. Professional CGM: Let’s get it on. Presented at: American Association of Diabetes Educators; Aug. 17-20, 2018; Baltimore.
Disclosure: Hughes reports no relevant financial disclosures.